临床判读结合超声测量直肠横径对儿童膀胱直肠功能障碍的诊断价值

The value of clinical interpretation combined with ultrasonic measurement of rectal transverse diameter in the diagnosis of cystorectal dysfunction in children

目的探讨临床判读联合经腹超声测量直肠横径(the rectum diameter,RD)对儿童膀胱直肠功能障碍(BBD)的诊断价值和临床应用。方法选取2020年7月至2022年4月在我院泌尿外科门诊因排尿排便异常病史而疑诊为BBD的患儿167例作为观察组,均经相关检查排除身体解剖结构及神经系统异常。随机选取其中46位儿童家长填写BBD调查问卷(排泄功能异常温哥华症状评分表)。选取同期健康体检儿童172例为对照组,均无排尿排便异常症状,检查显示身体结构无异常。超声对两组儿童经腹壁进行膀胱后方RD测量。结果观察组平均直肠横径(34.14±7.11)mm(95%CI:33.05~35.22),对照组平均直肠横径(23.74±8.84)mm(95%CI:22.41~25.07)。观察组平均RD水平显著高于对照组,差异有统计学意义(P<0.05)。观察组中,有调查问卷的儿童与无调查问卷的儿童平均直肠横径差异无统计学意义(P>0.05)。在治疗方案的选择上,临床判读+BBD调查问卷+超声直肠横径测量的诊断方法与仅有临床判读+超声直肠横径测量的诊断方法对最终治疗方案的选择差异无统计学意义(P>0.05)。结论经腹超声直肠横径测量为诊断儿童BBD提供了一个更客观的物理参数,临床判读结合超声RD测量是较准确且更简化的BBD诊断方法,有较显著的临床应用价值。

Objective To verify the significance of transabdominal ultrasound measurement of transverse rectal diameter(therectumdiameterRD)in the diagnosis of cystorectal dysfunction(BBD)in children,and to explore the value of clinical interpretation combined with ultrasound imaging in the selection of diagnosis and treat⁃ment.Methods A total of 167 children with suspected BBD in the urology clinic of our hospital from July 2020 to April 2022 were selected as the observation group,all of them had a history of abnormal urination and defecation,and the abnormalities of body anatomy and nervous system were excluded.46 parents with obvious symptoms were selected to fill in the BBD questionnaire.172 healthy children in the same period were selected as the control group,all of them had no abnormal urination and defecation and abnormal body structure.The RD of the posterior bladder was measured through the abdominal wall in two groups of children by ultrasound.Results The average RD of the observation group was(34.14±7.11)mm(95%CI:33.05~35.22),and that of the control group was(23.74±8.84)mm(95%CI:22.41~25.07).The average level of RD in the observation group was significantly higher than that in the control group(P<0.05).In the observation group,there was no significant difference in average RD between children with questionnaire and children without questionnaire.In the choice of treatment,there was no significant difference in the choice of final treatment between the diagnostic method of clinical interpre⁃tation+BBD questionnaire+ultrasonic RD measurement and the diagnostic method of clinical interpretation+ultrasonic RD measurement only.Conclusion Transabdominal ultrasound RD measurement provides a more intuitive and accurate physical parameter for the diagnosis of BBD in children,and has significant clinical application value.Clinical interpretation combined with ultrasonic RD measurement is a more accurate and simplified method for BBD diagnosis.